title: Field evaluation in Chad of community usage of CD4 T lymphocyte counting by alternative single-platform flow cytometry.
abstract: BACKGROUND
  Field and community evaluation of the routine usage of CD4 T counting platforms is essential in resource-poor countries for efficient and cost-effective monitoring of HIV-infected adults and children attending health care centers.
  
  
  METHODS
  We herein addressed the principal issues raised by the implementation of the single-platform, volumetric Auto40 flow cytometer (Apogee Flow Systems Ltd, Hemel Hempstead, UK) in 8 community HIV monitoring laboratories of different levels throughout Chad. This is a country with particularly difficult conditions, both in terms of climate and vast geographical territory, making the decentralization of the therapeutic management of HIV-infected patients challenging.
  
  
  RESULTS
  The routine usage of the Auto40 flow cytometers for a period of 5 years (2008-2013) confirms the reliability and robustness of the analyzer for community-based CD4 T cell enumeration in terms of both absolute numbers and percentages to enable accurate monitoring of HIV-infected adults and children. However, our observations suggest that the Auto40 mini flow cytometer is not suitable for all laboratories as it is oversized and ultimately very expensive.
  
  
  CONCLUSIONS
  The Chad experience with the Auto40 flow cytometer suggests that its usage in resource-limited settings should be mainly reserved to reference (level 1) or district (level 2) laboratories, rather than to laboratories of health care centres (level 3).
authors.affiliation: Ministère de la Santé Publique, BP 407 N'Djamena, Chad. koyaltad@yahoo.fr.
authors.forename: Donato
authors.initials: D
authors.lastname: Koyalta
authors.forename: Mohammad-Ali
authors.initials: MA
authors.lastname: Jenabian
authors.forename: Barou
authors.initials: B
authors.lastname: Djouater
authors.forename: Noël
authors.initials: N
authors.lastname: Djemadji-Oudjeil
authors.forename: Francois-Xavier
authors.initials: FX
authors.lastname: Mbopi-Keou
authors.forename: Angélique
authors.initials: A
authors.lastname: Ndjoyi-Mbiguino
authors.forename: Laurent
authors.initials: L
authors.lastname: Bélec
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count / Q000295:instrumentation / Q000379:methods*; D002596:Chad; D002648:Child; D005434:Flow Cytometry / Q000295:instrumentation / Q000379:methods*; D015658:HIV Infections / Q000175:diagnosis; D006801:Humans